Using Gender to Examine Gender Concepts Using Gender to Examine Ill-Health Dr Alpana Sagar Centre of Social Medicine and Community Health Jawaharlal Nehru University New Delhi, India alpanasagar@yahoo.com

Multifactorial nature of ill-health Amongst various factors two that are being considered: 1. Sex: Determined by biology 2. Gender: A social and cultural construct that prescribes norms of behaviour for men and women - masculinity for men and femininity for women, and therefrom assigns them social roles These norms define: dress, attributes behaviour and roles

Attributes and Behaviour 1 Gender concepts Attributes and Behaviour Women Emotional Gentle Caring Nurturing Obedient Self-sacrificing Tolerant Men Rational Strong Competitive Aggressive Self confident

1 Gender concepts Roles Women Homemakers Mothers Wives Daughters Daughters-in -law Nurturers Subordinate to men Men Heads of households Breadwinners Professional achievers Carry on bloodline

2. Gender and Health - Mortality Differentials While gender is responsible for attributes and norms of behaviour as well as for defining social roles can we say it has any implications for health?

1 Gender concepts The Implications of Gender for Health 1. Differences in mortality patterns 2. Differences in health seeking behaviour 3. Women’s Reproductive /Maternal Health emphasized more than their overall health Policy Implications

2. Gender and Health - Mortality Differentials

2. Gender and Health - Mortality Differentials While women are known to be the biologically stronger sex can biological causes of mortality be overridden by social causes for mortality? What does a closer look at data on mortality of males and females by infectious and parasitic diseases reveal?

Often biological causes are overridden by social causes 2. Gender and Health - Mortality Differentials Often biological causes are overridden by social causes

Often biological causes are overridden by social causes ct. 2. Gender and Health - Mortality Differentials Often biological causes are overridden by social causes ct.

Not only do social causes affect mortality, 3. Gender and Health - Health Seeking Behaviour Not only do social causes affect mortality, gender socialization also affects morbidity reporting and health seeking behaviour

3. Gender and Health - Health Seeking Behaviour While mortality is highest for girls under 14 years of age morbidity reporting and medical care is lowest for this group For women in the reproductive age group while reported morbidity is more than males of same age, commensurate medical care is not sought

3. Gender and Health - Health Seeking Behaviour It is also worth noting that morbidity reporting is not the same for all women but differs by income groups While mortality is known to decrease with increasing income, the reporting of morbidity has increased with increasing income

•Women’s own acceptance of illness due to their socialization 3. Gender and Health - Health Seeking Behaviour What is explanation for this disjunction between women’s morbidity and health seeking behaviour •Women’s own acceptance of illness due to their socialization •Social definitions of women’s health by their social figures of authority - husbands and mothers-in -law •Medical definitions of women’s health by doctors

So what is the result of women’s ill health not being legitimized 3. Gender and Health - Health Seeking Behaviour So what is the result of women’s ill health not being legitimized Women’s morbidity is thus underreported Treatment seeking behaviour is affected

Is this in consonance with the data on women’s health? 4. Social understanding of women’s health Not only does women’s state of health get defined socially, a gendered understanding of women also impacts the way in which their problems of ill health are viewed Most health programs tend to emphasize women’s reproductive or maternal health rather than their over all health Is this in consonance with the data on women’s health?

What is the distribution of causes of mortality in women? 4. Social understanding of women’s health What is the distribution of causes of mortality in women?

4. Social understanding of women’s health Additionally percentage of deaths for women is not highest in reproductive age group

4. Social understanding of women’s health Then why despite evidence to the contrary, is women’s health linked so strongly to their reproductive health? There are many reasons one of which is the historical understanding of reproduction being woman’s most important function

Policy Implications AN UNDERSTANDING OF THE IMPORTANCE OF THE IMPACT OF LARGER SOCIAL STRUCTURES ON THE HEALTH OF BOTH MEN AND WOMEN. THE NEED FOR LARGER SOCIAL CHANGES TO IMPROVE THE POSITION OF WOMEN THIS LEADS TO THE RECOGNITION FOR EMPHASIZING INTERSECTORAL LINKAGES FOR PUBLIC HEALTH A CHANGE OF EMPHASIS FROM REPRODUCTIVE TO GENERAL HEALTH IN HEALTH PROGRAMS WOULD HELP IMPROVE WOMEN’S OVER ALL HEALTH

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